Warning Strokes: Why They’re Anything but “Mini”

By Kristen De Deyn Kirk, Sponsored by Sentara Northern Virginia Medical Center

TIAs, once referred to as “mini strokes,” can be an indicator of major health concerns.

Andrea Helmbach, MSN, RN, SCRN, was relieved when she recently read about updated stroke treatment guidelines. As stroke program manager at Sentara Northern Virginia Medical Center, she knew her accredited stroke facility already implemented the protocols years ago. She was also comforted that others would soon do the same.

Top among the recommendations (published in January 2023 in Stroke at American Heart Association Journals): Drop the term “mini stroke.” Many people use the misnomer to describe a Transient Ischemic Attack (TIA), stroke symptoms (see box) that last from one to 24 hours and may stop without intervention.

“A TIA is really a warning stroke,” Helmbach says, “and a blessing stroke.”

Equal Treatment for All

Patients experiencing stroke symptoms — regardless of the severity — should be helped the same way, Helmbach explains.

With the newest protocols, medical providers are asked to:

• Conduct a CT (computed tomography) scan of the patient’s head to rule out an earlier stroke and look for bleeding

• Recommend a CT angiogram, which involves injecting a dye into the patient and evaluating blood vessels from the top of the aorta (the main artery which starts in the heart) to the cerebral vasculature (veins and arteries in the brain) for a blockage

• Consult with a neurologist for an immediate exam and review of the CT and the CT angiogram

• Consider and possibly give a clot-busting drug

• Offer an MRI (magnetic resonance imaging) to check finer details inside the body

• Prescribe medications which may include aspirin and statins to decrease LDL, the “bad cholesterol”

• Schedule a follow-up appointment with a neurologist

• Track compliance (how well patients follow medical advice, including implementing healthy lifestyle practices and taking medications)

But why do all this, especially if a patient’s stroke symptoms have stopped quickly?

“Sometimes a TIA can resolve, and then recur very soon,” Helmbach says, “and sometimes there’s what's called ‘crescendo TIAs,’ where you get multiple, little bouts of TIAs, and then all of a sudden there's a full-blown stroke.”

Signs Of A Stroke

The American Stroke Association suggests the following acronym to identify and start treatment for a stroke:

B for balance. Is the person dizzy or off balance?

E for eyes. Is his or her vision blurry?

F for face drooping or numbness. Is the person’s smile uneven?

A for arm weakness or numbness. When the person raises his or her arm, does one drift down?

S for speech difficulties. Is his or her speech slowed or slurred?

T for time to call 9-1-1.

Even if you live near a hospital, resist the temptation to drive there. You’ll receive the needed care faster by calling 9-1-1, Andrea Helmbach, MSN, RN, SCRN, Sentara stroke program manager, says. She works closely with local EMS crews and has observed that their specialists can immediately assist stroke patients — whether their symptoms are mild or major. They quickly transport patients to an emergency department for additional care.

Patients with a warning stroke face concerning odds:

• About one in five will have a stroke within three months

• About one in 10 will experience a stroke within a few days

Fast and Thorough Treatments Make a Difference

Helmbach has read estimates that 240,000 Americans a year experience TIAs. She believes the number is much higher.

“So many people, when they do come in with a stroke, say ‘Well, yeah, I kind of had these symptoms a couple of weeks ago, but I laid down and took a nap and woke up, and they were gone. So I didn't think much of it’,” she says. “That was their warning stroke. If you ignore it, then we don't get the opportunity to intervene. It's extremely important that they come in.”

Her advice: Call 9-1-1 at the first sign of symptoms. The stroke program manager wants patients to have hope.

“If we get people on the right regime, and they do some lifestyle modifications as well,” Helmbach says, “it's thought that we can prevent about 80% of the strokes that occur.”

Kristen De Deyn Kirk is a Virginia freelance writer specializing in healthcare and technology.